title: Safety and outcomes of cryoablation for ventricular tachyarrhythmias: results from a multicenter experience.
abstract: BACKGROUND
  Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported.
  
  
  OBJECTIVE
  The purpose of this study was to assess the feasibility and safety of cryoablation for VA.
  
  
  METHODS
  Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate.
  
  
  RESULTS
  Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45% ± 5%. In 15 (45%) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55%) patients. Cryoablation was successful in all parahisian cases (100%). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA.
  
  
  CONCLUSIONS
  Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed.
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahamad
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Henry H
authors.initials: HH
authors.lastname: Hsia
authors.forename: Javier
authors.initials: J
authors.lastname: Sanchez
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Shane
authors.initials: S
authors.lastname: Bailey
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: G Joseph
authors.initials: GJ
authors.lastname: Gallinghouse
authors.forename: David J
authors.initials: DJ
authors.lastname: Burkhardt
authors.forename: Dhanunjay
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Yanfei
authors.initials: Y
authors.lastname: Yang
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.forename: Melvin
authors.initials: M
authors.lastname: Scheinman
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Gery
authors.initials: G
authors.lastname: Tomassoni
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D018780:Body Surface Potential Mapping; D003452:Cryosurgery / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome